title: Association between the vaginal microbiota, menopause status, and signs of vulvovaginal atrophy.
abstract: OBJECTIVE
  The vaginal microbiota helps protect the female genital tract from disease. We sought to describe the composition of the vaginal microbiota in premenopausal, perimenopausal, and postmenopausal women and to explore the association between the microbiota and vulvovaginal atrophy (VVA).
  
  
  METHODS
  Eighty-seven women (aged 35-60 y) were classified as premenopausal (n = 30), perimenopausal (n = 29), or postmenopausal (n = 28) according to Stages of Reproductive Aging Workshop guidelines. Midvaginal bacterial community composition was characterized by 16S ribosomal RNA gene analysis.
  
  
  RESULTS
  Bacterial communities clustered into six community state types (CSTs), of which four were dominated by Lactobacillus crispatus, Lactobacillus gasseri, Lactobacillus iners, or Lactobacillus jensenii, and two (CST IV-A and CST IV-B) had low relative abundance of Lactobacillus. CST IV-A was characterized by Streptococcus and Prevotella, whereas CST IV-B was characterized by Atopobium. There were significant associations between menopause stage and CST (P = 0.004) and between VVA and CST (P = 0.002). Perimenopausal women were more likely to be classified as CST IV-A or L. gasseri CST, whereas postmenopausal women were often classified as CST IV-A. CSTs dominated by L. crispatus and L. iners were more prevalent in premenopausal women. Nineteen participants had signs of mild or moderate VVA. Compared with women with no VVA, the vaginal microbiota of women with mild or moderate atrophy had 25-fold greater odds of being classified as CST IV-A versus L. crispatus CST (adjusted odds ratio, 25.89; 95% credible interval, 2.98-406.79).
  
  
  CONCLUSIONS
  A distinct bacterial community state (CST IV-A) with a low relative abundance of Lactobacillus is associated with VVA. Future studies recruiting a larger number of women are needed to replicate the findings. This study provides an impetus for future longitudinal studies designed to manage, modulate, and restore vaginal microbiota homeostasis, which would provide stronger evidence for a causal relationship with VVA and ultimately improve the treatment and prevention of atrophic vaginitis in menopause.
authors.affiliation: From the 1Institute for Genome Sciences and 2Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; 3Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Departments of 4Pediatrics and Neurovirology and 5Obstetrics and Gynecology, Johns Hopkins School of Medicine, Baltimore, MD; and 6Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Brotman
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Shardell
authors.forename: Pawel
authors.initials: P
authors.lastname: Gajer
authors.forename: Doug
authors.initials: D
authors.lastname: Fadrosh
authors.forename: Kathryn
authors.initials: K
authors.lastname: Chang
authors.forename: Michelle I
authors.initials: MI
authors.lastname: Silver
authors.forename: Raphael P
authors.initials: RP
authors.lastname: Viscidi
authors.forename: Anne E
authors.initials: AE
authors.lastname: Burke
authors.forename: Jacques
authors.initials: J
authors.lastname: Ravel
authors.forename: Patti E
authors.initials: PE
authors.lastname: Gravitt
mesh_terms: D000328:Adult; D001284:Atrophy; D005260:Female; D006801:Humans; D007778:Lactobacillus / Q000302:isolation & purification / Q000502:physiology; D008593:Menopause / Q000502:physiology*; D064307:Microbiota; D008875:Middle Aged; D015999:Multivariate Analysis; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA; D014621:Vagina / Q000382:microbiology* / Q000473:pathology; D014844:Vulva / Q000473:pathology
chemical_list: D012336:RNA, Ribosomal, 16S